Adherence, safety, and satisfaction of a cardio-oncology rehabilitation program framework versus community exercise training for cancer survivors: findings from the CORE trial

Viamonte, Sofia; Joaquim, Ana; Alves, Alberto Jorge; Vilela, Eduardo; Capela, Andreia; Ferreira, Cristina; Costa, Ana João; Teixeira, Madalena; Duarte, Bárbara; Rato, Nuno; Tavares, Aida Isabel; Santos, Mário; Ribeiro, Fernando

doi:10.1007/s00520-023-07638-1

Cited by 4 publications

(3 citation statements)

References 48 publications

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“…No serious adverse events related to exercise were reported. A detailed description regarding the compliance and safety of the CORE trial has been previously provided …”

Section: Resultsmentioning

confidence: 99%

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Cardio-Oncology Rehabilitation for Cancer Survivors With High Cardiovascular Risk

Viamonte,

Joaquim,

Alves

et al. 2023

JAMA Cardiol

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ImportanceCardiovascular disease is a leading cause of morbidity in cancer survivors, which makes strategies aimed at mitigating cardiovascular risk a subject of major contemporary importance.ObjectiveTo assess whether a center-based cardiac rehabilitation (CBCR) framework compared with usual care encompassing community-based exercise training (CBET) is superior for cardiorespiratory fitness improvement and cardiovascular risk factor control among cancer survivors with high cardiovascular risk.Design, Setting, and ParticipantsThis prospective, single-center, randomized clinical trial (CORE trial) included adult cancer survivors who had exposure to cardiotoxic cancer treatment and/or previous cardiovascular disease. Enrollment took place from March 1, 2021, to March 31, 2022. End points were assessed at baseline and after the 8-week intervention.InterventionsParticipants were randomly assigned in a 1:1 ratio to 8 weeks of CBCR or CBET. The combined aerobic and resistance exercise sessions were performed twice a week.Main Outcomes and MeasuresThe powered primary efficacy measure was change in peak oxygen consumption (V̇o2) at 2 months. Secondary outcomes included handgrip maximal strength, functional performance, blood pressure (BP), body composition, body mass index (BMI; calculated as weight in kilograms divided by height in meters squared), lipid profile, plasma biomarker levels, physical activity (PA) levels, psychological distress, quality of life (QOL), and health literacy.ResultsA total of 75 participants completed the study (mean [SD] age, 53.6 [12.3] years; 58 [77.3%] female), with 38 in the CBCR group and 37 in the CBET group. Participants in CBCR achieved a greater mean (SD) increase in peak V̇o2 than those in CBET (2.1 [2.8] mL/kg/min vs 0.8 [2.5] mL/kg/min), with a between-group mean difference of 1.3 mL/kg/min (95% CI, 0.1-2.6 mL/kg/min; P = .03). Compared with the CBET group, the CBCR group also attained a greater mean (SD) reduction in systolic BP (−12.3 [11.8] mm Hg vs −1.9 [12.9] mm Hg; P &lt; .001), diastolic BP (−5.0 [5.7] mm Hg vs −0.5 [7.0] mm Hg; P = .003), and BMI (−1.2 [0.9] vs 0.2 [0.7]; P &lt; .001) and greater mean (SD) improvements in PA levels (1035.2 [735.7] metabolic equivalents [METs]/min/wk vs 34.1 [424.4] METs/min/wk; P &lt; .001), QOL (14.0 [10.0] points vs 0.4 [12.9] points; P &lt; .001), and health literacy scores (2.7 [1.6] points vs 0.1 [1.4] points; P &lt; .001). Exercise adherence was significantly higher in the CBCR group than in the CBET group (mean [SD] sessions completed, 90.3% [11.8%] vs 68.4% [22.1%]; P &lt; .001).Conclusion and RelevanceThe CORE trial showed that a cardio-oncology rehabilitation model among cancer survivors with high cardiovascular risk was associated with greater improvements in peak V̇o2 compared with usual care encompassing an exercise intervention in a community setting. The CBCR also showed superior results in exercise adherence, cardiovascular risk factor control, QOL, and health literacy.Trial RegistrationClinicalTrials.gov Identifier: NCT05132998

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“…No serious adverse events related to exercise were reported. A detailed description regarding the compliance and safety of the CORE trial has been previously provided …”

Section: Resultsmentioning

confidence: 99%

“…A detailed description regarding the compliance and safety of the CORE trial has been previously provided. 41…”

Section: Adherence and Safetymentioning

confidence: 99%

Cardio-Oncology Rehabilitation for Cancer Survivors With High Cardiovascular Risk

Viamonte,

Joaquim,

Alves

et al. 2023

JAMA Cardiol

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“…Physical inactivity is not only a risk factor to develop cancer but is also a predictor for HF and cardiovascular death [ 154 ]. Exercise interventions, both AET (MCT and HIIT) and RT, during chemotherapy have been shown to be safe and applicable [ 155 , 156 ] and have the potential to improve CRF and prevent development of long-term HF [ 97 , 157 , 158 ] by affecting multiple molecular pathways. This should trigger the implementation of exercise training as an adjunct to standard cancer-related therapy in the form of cardio-oncological rehabilitation, which is not generally available despite “guideline recommendations” [ 8 , 159 – 162 ].…”

Section: Discussionmentioning

confidence: 99%

Relevance of Cardiovascular Exercise in Cancer and Cancer Therapy-Related Cardiac Dysfunction

Wernhart,

Rassaf

2024

Curr Heart Fail Rep

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Purpose of the Review Cancer therapy-related cardiac dysfunction (CTRCD) has been identified as a threat to overall and cancer-related survival. Although aerobic exercise training (AET) has been shown to improve cardiorespiratory fitness (CRF), the relationship between specific exercise regimens and cancer survival, heart failure development, and reduction of CTRCD is unclear. In this review, we discuss the impact of AET on molecular pathways and the current literature of sports in the field of cardio-oncology. Recent Findings Cardio-oncological exercise trials have focused on variations of AET intensity by using moderate continuous and high intensity interval training, which are applicable, safe, and effective approaches to improve CRF. Summary AET increases CRF, reduces cardiovascular morbidity and heart failure hospitalization and should thus be implemented as an adjunct to standard cancer therapy, although its long-term effect on CTRCD remains unknown. Despite modulating diverse molecular pathways, it remains unknown which exercise regimen, including variations of AET duration and frequency, is most suited to facilitate peripheral and central adaptations to exercise and improve survival in cancer patients.

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Cost-effectiveness analysis of a cardio-oncology rehabilitation framework compared to an exercise intervention for cancer survivors with high cardiovascular risk

Viamonte,

Tavares,

Alves

et al. 2024

European Journal of Preventive Cardiology

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Background A cardio-oncology rehabilitation model among cancer survivors showed superior results comparing to a community-based exercise intervention. However, questions remain about its cost-effectiveness. Aims To assess the cost-effectiveness of a center-based cardiac rehabilitation (CBCR) program when compared to usual care encompassing a community-based exercise training (CBET), among cancer survivors with high cardiovascular risk. Methods The CORE study was a single-center, prospective, randomized controlled trial; 80 adult cancer survivors with previous exposure to cardiotoxic cancer treatment and/or with previous cardiovascular disease were assigned (1:1 ratio) to an 8-week CBCR or CBET, twice/week. Cost-effectiveness was a pre-specified secondary endpoint. Outcomes included healthcare resource use and costs, quality-adjusted life-years (QALYs) and cost-effectiveness; incremental cost-effectiveness ratio (ICER) was computed from a societal perspective. Results 75 patients completed the study (CBCR N=38; CBET N=37). The CBCR had significantly higher cost per patient (477.76 ± 39.08€) compared to CBET group (339.32 ± 53.88€), with a significant between-group difference 138.44€ (95% CI, 116.82 to 160.05€, p<0.01). A between-group difference by 0.100 points in QALYs was observed, favouring the CBCR (95% CI, -0.163 to -0.037, p=0.002). When CBCR was compared with CBET, the ICER was €1,383.24 per QALY gained; at a willingness-to-pay threshold of €5,000 per QALY, the probability of CBCR being cost-effective was 99.9% (95% CI, 99.4 to 100.0). Conclusion The CORE trial shows that a CBCR is a cost-effective intervention in the management of cancer survivors with high cardiovascular risk, reinforcing the potential benefits of this multidisciplinary approach in supportive care of this specific subset of cancer patients.

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Adherence, safety, and satisfaction of a cardio-oncology rehabilitation program framework versus community exercise training for cancer survivors: findings from the CORE trial

Cited by 4 publications

References 48 publications

Cardio-Oncology Rehabilitation for Cancer Survivors With High Cardiovascular Risk

Cardio-Oncology Rehabilitation for Cancer Survivors With High Cardiovascular Risk

Relevance of Cardiovascular Exercise in Cancer and Cancer Therapy-Related Cardiac Dysfunction

Cost-effectiveness analysis of a cardio-oncology rehabilitation framework compared to an exercise intervention for cancer survivors with high cardiovascular risk

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